Healthcare Provider Details

I. General information

NPI: 1093620122
Provider Name (Legal Business Name): MIDNIGHT PINE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BOWERS HILL RD
OXFORD CT
06478-1756
US

IV. Provider business mailing address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

V. Phone/Fax

Practice location:
  • Phone: 860-307-1368
  • Fax:
Mailing address:
  • Phone: 860-307-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICTORIA L EGAN
Title or Position: COUNSELOR
Credential: LPC
Phone: 860-307-1368